Division of Cardiothoracic Surgery, UC Davis Medical Center, Sacramento, USA.
MedTech Epidemiology and Real-World Data Sciences, Johnson & Johnson, 410 George Street, New Brunswick, NJ, 08901, USA.
J Cardiothorac Surg. 2022 Aug 28;17(1):212. doi: 10.1186/s13019-022-01956-x.
To compare clinical and economic outcomes after sternotomy for cardiac surgery with skin closure through 2-octyl cyanoacrylate plus polymer mesh tape (2OPMT) versus conventional absorbable sutures plus waterproof wound dressings (CSWWD).
Retrospective study using the Premier Healthcare Database. Patients undergoing a cardiac surgery requiring sternotomy with 2OPMT or CSWWD were included. Primary outcome was 60-day cumulative incidence of diagnosis for wound complications (infection, dehiscence). Secondary outcomes were index admission hospital length of stay (LOS), total hospital-borne costs, discharge status, and 60-day cumulative incidences of inpatient readmission and reoperation. After propensity score matching, outcomes were compared between the 2OPMT and CSWWD groups using bivariate multilevel mixed-effects generalized linear models.
Overall, 7,901 2OPMT patients and 10,775 CSWWD patients were eligible for study. After propensity score matching on 68 variables, each group comprised 5,338 patients (total study N = 10,676). The 2OPMT and CSWWD groups did not differ significantly in terms of the 60-day cumulative incidences of wound complication (3.47% vs 3.47%, p = 0.996), inpatient readmission (12.6% vs. 13.6%, p = 0.354), and reoperation (10.3% vs 10.1%, p = 0.808), as well as discharge to home versus non-home setting (77.2% vs. 75.1%), p = 0.254. However, the 2OPMT group had significantly lower LOS (9.2 days vs 10.6 days, p < 0.001) and total hospital-borne costs ($50,174 vs $60,526, p < 0.001).
This large observational study provides evidence that sternotomy skin closure with 2OPMT is associated with nearly identical 60-day cumulative incidence of wound complication as compared with CSWWD, while exhibiting a significant association with lower LOS and total hospital-borne costs. Trial registration Not applicable.
比较心脏手术后经胸骨切开术采用 2-辛基氰基丙烯酸酯加聚合物网带（2OPMT）与传统可吸收缝线加防水伤口敷料（CSWWD）进行皮肤闭合的临床和经济结局。
使用 Premier Healthcare Database 进行回顾性研究。纳入接受心脏手术且需要胸骨切开术并采用 2OPMT 或 CSWWD 进行皮肤闭合的患者。主要结局为 60 天累计诊断伤口并发症（感染、裂开）的发生率。次要结局为指数住院期间的住院时间（LOS）、总医院相关费用、出院状态以及 60 天内的住院再入院和再次手术的累计发生率。在进行倾向评分匹配后，使用二元多水平混合效应广义线性模型比较 2OPMT 和 CSWWD 两组之间的结局。
总体而言，7901 例 2OPMT 患者和 10775 例 CSWWD 患者符合研究条件。在对 68 个变量进行倾向评分匹配后，每组各有 5338 例患者（总计 10676 例患者）。2OPMT 和 CSWWD 两组在 60 天内伤口并发症（3.47%比 3.47%，p=0.996）、住院再入院（12.6%比 13.6%，p=0.354）和再次手术（10.3%比 10.1%，p=0.808）的 60 天累计发生率、出院至家庭与非家庭环境（77.2%比 75.1%，p=0.254）方面无显著差异。然而，2OPMT 组的 LOS（9.2 天比 10.6 天，p<0.001）和总医院相关费用（50174 美元比 60526 美元，p<0.001）显著降低。
这项大型观察性研究提供了证据，表明与 CSWWD 相比，经胸骨切开术皮肤闭合采用 2OPMT 与 60 天内伤口并发症的累计发生率几乎相同，同时与 LOS 较短和总医院相关费用较低显著相关。
不适用。
